Provider Demographics
NPI:1316042245
Name:ADVANCED INTERVENTIONAL PAIN CENTER SC
Entity Type:Organization
Organization Name:ADVANCED INTERVENTIONAL PAIN CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:YUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-209-2463
Mailing Address - Street 1:2320 DEAN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-1068
Mailing Address - Country:US
Mailing Address - Phone:630-377-0106
Mailing Address - Fax:630-377-1186
Practice Address - Street 1:2210 DEAN ST
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1066
Practice Address - Country:US
Practice Address - Phone:847-209-2463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty